i. Urgent Care Centre
ii. Queens/King Georges A&E
iii. Planned closure of King Georges A&E
iv. Progress on joint projects with Urgent Care Board and Integrated Care Board
Verbal Update by BHRUT
Minutes:
The Chairman welcomed Averil Dongworth, Chief Executive Officer of the Queens Hospital Trust. The Board noted the following updates:
Urgent Care Centre
The Urgent Care Centre utilisation rates were up to 32% and the CCGs were being provided with weekly reports. At the HWB Board meeting of 14 August 2013, there was a discussion about the contracted level of 45%-50%. These figures were based on a clinical audit that would agree a trajectory to increase utilisation. The audit was currently with the CCG. Original utilisation rates were very low and it had been a slow process to increase the figure to 32%. The figure had been benchmarked with other outer London Trusts where it was found to be below the average figure of 33-34%.
Members of the Board expressed their concern in that they considered 32% a low take up in usage of the Urgent Care Centre and asked what measures were being put in place to increase the figure.
The Chief Executive of BHRUT advised that it was essential to put the right patients with the right treatment in the right place. A lot of work was done to stream patients or redirect them to GPs on arrival in A&E. The Trust would like to achieve a utilisation figure of 40 % and work was on-going in developing the NHS England UCC model and using it as a template. It was also the view of the Chief Executive of BHRUT that the CCG ought to pay the right tariffs for work done and that a clinical audit would help in addressing this issue. The CCG were billed for patient’s treatments, however if temporary staff were not recording treatments appropriately, then information could not be correctly coded which in turn affected the figures. It was therefore very important to have permanent staff and a modern IT system.
A member representing the CCG advised that the CCGs had not been very proactive in the past but would be leading now as they had a better understanding of the position. A&E admissions had decreased slightly whilst attendances had increased marginally and there was still a lot of work to do. UCC utilisation rates were only 23% 2 years ago and the CCG would be investigating how the service is commissioned.
It was noted that Queens A&E was being redeveloped. There would be separate doors to A&E and the UCC which would make it easier to staff.
It was confirmed that both UCCs at Harold Wood and Queens Hospital were operated by the same provider. The Chairman questioned why the Harold Wood centre was not being run according to the original plan of closing at 8.00pm and closed its doors to new patients at 6.00 pm. The centre should support 6 GPs and provide a 24 hour service. The representative from NHS England said that he would raise this issue in a meeting with primary care colleagues. The Chairman offered to forward the original plans if required.
The Chief Executive of BHRUT affirmed that when ambulances ceased to arrive at King Georges, it was anticipated that 65/70% would still attend the Urgent Care Centre. From thereon ambulances would travel to either Whipps Cross or Queens Hospitals.
Queens/King George’s A&E
The Chief Executive confirmed that there were plans to close the A&E at King George’s Hospital to blue light admissions from ambulances around late summer in 2015. A lot of work would be carried out before then at Queens. Queens Hospital was a PFI hospital and it was important to get everything right. There were deadlines to meet and issues around clinical modelling. The Trust was working with PFI partners and clinicians had approved the plans.
Following the Clinical Review, the recommendation was that King George’s A&E would not close until it was safe to do so and that the redevelopment of Queens A&E was complete. The Clinical Review had also made a number of recommendations and that these were now work in progress.
The Chair expressed a view that there had been no discussion with the Local Authority nor had there been a meeting with the Council Cabinet to discuss health matters, particularly the plans regarding A&E closure to ambulances. The Chief Executive gave her apologies and stated that the Health and Wellbeing Board was new and that she was prepared to hold discussions with anyone at any time. A member representing the CCG stated that in the past PCTs had not been very good in communicating. The Chief Executive concurred with this view stating that the NHS itself had not excelled in this area and that in going forward, there should be more engagement with groups including Healthwatch so that all parties were clear on strategy.
The Board noted that there needed to be some clarity about the definition of an Urgent Care Centre. The Chairman of Healthwatch pointed out that patients often have a problem with what things are called by the health system. This needed to be clarified for patients to help them navigate the health system better and should be communicated nationally and locally.
Joint Projects UCB/ICB
(i) Recruitment
The Trust had formed an agreement with the Local Education Training Board (LETB, or Deanery) for 10 Clinical Fellows for introduction to Clinical Fellows/Leadership Management programmes. Efforts were also being made to repeat the same in nursing. There were joint appointments with Barts Health via the Trauma Centre and that there would be a new cohort of emergency doctors. UCB had been helpful in the task of promoting Romford as a place to live and work. Representatives from the Trust would also be travelling to India to recruit more staff. The Trust had to compete with inner London Trusts providing Acute Trauma as well as overcoming the reputation of the hospital.
(ii) Seven Day Working
7 Day Working had now been implemented in Queen’s Hospital since the beginning of September, but was still not really delivering yet. The Trust had been looking at blockages in the system, however, it was confirmed that 7 Day Working was delivering a better quality of care to patients. Patients were able to see a Doctor on the ward on a Friday or Saturday which produced better outcomes. It has also been found to produce a surge of patient discharges on a Tuesday. The Trust would continue to monitor this closely as a pattern had not developed yet.
(iii) Joint Discharge
The Chief Executive of BHRUT noted and thanked the Director of Adult Social Services for her personal involvement in addressing a recent discharge problem.
(iv) Frail Elderly
A programme had begun of trialling extended opening hours over the weekends by primary care providers so as to increase the number of appointments in the system. Research was also being undertaken in conjunction with UCL on looking at data for around 500 patients audited last month to see how improvements to services can be made and the processes simplified.
The Chairman on behalf of the Board thanked the Chief Executive of BHRUT and extended an invitation to report to the HWB Board on a regular basis. The Health and Social Care Sectors were undergoing change and that health partners needed to understand how Cabinet and Scrutiny worked. It was therefore agreed that the Chief Executive would attend the HWB Board meeting to present a progress update in two months.